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Home My WebLink About018-1094-32-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430015 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: S inks, Ernest Hammond Township 018 - 1094 -32 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 0 17.29.17. TANK INFORMATION ELEVATION DATA TYPE MANUFACTUREt, CAPACITY STATION BS HI FS ELEV. Septic Benchmark { Dosing Alt. BM S T • /,o Z. zfp Aeration _ Bldg. Sewer Holding S Ht Inlet TANK SETBACK INFORMATION Ht Outlet TANK TO , ^ P / /L ,, WELL BLDG. Vent to Air Intake ROAD Dt Inlet w Y S _^ Septic 4-) / Dt Bottom Dosing Header /Man. Aeration Dist. Pip 67,rs Z G� Holding Bot. System PUMP /SIPHON INFORMATION Final Grade I Manufacturer Demand St Comer �• !� ��. �� GPM (p ^ 3 -Z '231 COZ Z Model Numb TDH Lift Fric System Head TDH Ft Forcemain ngth Dia. D SOIL ABSORPTION SYSTEM G BED/TRENCH Width Lent No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `� SETBACK SYSTEM TO AAA P/L BLDG WELL LAKE /STRE LEACHING Manuf Curer• INFORMATION CHAMBER O J f� Ty Of System: I 1 V dal UNIT Model Number: DISTRIBUTION SYSTEM zk,/ " ", k C( Head a ifold Distribution x Hole Size x Hole Spacing W it Intake ti Pipes) Q N d Length Dia Length f� Dia Spacing ,. 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil E],, Yes [] No [�] Yes (_� No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 1 0 Inspection #2: Location: 1682 99th Ave Hammond, h WI 54015 (NW 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 32 T Parcel No: 17.29.17. 1.) Alt BM Description = ST'S' / 2.) Bldg sewer length =S8 - amount of cover => I� r a-�I Plan revision Required? Yes t f -7 11 63 �/ 71 Use other side for additional information. �_ � L , 7�a ___j i SBD -6710 (R.3/97) Date Insepcto s Signature Cert. No. 10 C MV- Safety and Bui dings Division County ` a+ w 201 W Washington Ave., PA, Box 7082 - iseonsin Madison, WI 53707 - 7082 Sanitary Permit Number to be filled in by Co.) Department of Commerce 1 (608) 261 -6546 -3000 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83:21, Wis. Adm. Code, personal information you provide may be used for secondary Lew, s 15.04(1 Xm) Jact ��h ti n address . 8 ) L Application Information - Please Print 11 Informs - j' Property Owner's Name �Py w Parcel N Lot N 3 Hl xk N !', Property Owner's Mailing A drat Property Location u w..,.:' %, City, State "Lip Code Phorie . Number t-A, Section — .Z_Z S (circlr o e) II. a of Building T� N; R„`ZE ot( � T yp e B (check all that apply) ono � est�otM� 1 or 2 Family Dwelling - Number of Bedrooms tx� Subdivision Name GSAQ- A{nm,er ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Vii a ownship of III. Type )f Permit: (Check only one box on line A. Complete line B If applicable) A ' ;ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System I B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner [V, T mx of POWT$ system; Check all that appl O Non - Pressurized In- Oround ❑ Mound 2 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter U Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Dri Line ❑ C vcl•less Pi ❑ Other (explain V. Dispersal/Treatment Area Information: Z 7 p Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (s() System Elevation as S7 V1. Tank Info Capacity In Toted Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ Aerobic Treatment Unit Dosing t:traober VII. Resp onsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plallL Plumbs' ame (Prig t)� Plum s pature r MP/MPRS Number Business Phone Number G. Plumber's Address (Straw, C State, Zip Code) Ln 21- VI11. Coun /De ar(ment Use Onl / KApproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ng Agent Sigma Stamps) Surcharge Fee) I 'D Owner Given Reason for Denial 1" 03 IX. Conditions of Approval/Reasons for Disapproval / AtVck complete plans (to the County only) for the system an paper mot less than 81Q s 11 Inches In dae SBD -6398 (R. 08/02) i i � Q I t - -!- t- - -- i I I j I , ! I I I ! I i — 7 - - — - 1 ---- - -- jo L l -- I t ! I (- - j j i I i ( I I I �- i ' I I 1 ! j i Al`A /7- � iJ/ �5 iiJ fcG. 8 S/ ✓glln A � - ,P5 I i' CT y' i � r - s;33 r` 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). w JJ A, � 55130 /0 3 Property Owner Property Location Govt. Lot 1/4 1/4 S T N R E (or)O Property Owner's Maili g Address Lot # Bloc # Su bd. me or CSM# ., City State Zip Code Phone Number P sj Village J&Town Nearest Road New Construction Use - F-� Residential / Number of bedrooms ' C de derived design flow ra e GPD 41 1 AY ❑ Replacement ❑ Public or commercial - Describe: ) r' R, Parent material lood i glevation if applicabll ft. General comments 7 and recommendations: ss _ ZO .NVG w F-/1 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor Pit � p 9 in. /Jr? Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 z Boring # ❑ Boring Pit Ground surface elev. ,fir " ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 5 -33 6 : ZZ d / — * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent_ #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Nam (Pease rint) / Signature I i CST Number J Address Dat valuation Conducted Telephone Number SBD -8330 (R07 /00) Property Owne ��,' j�(.� Parcel ID # AM- Page of F - Boring # ❑ Boring 3 Pit Ground surface el ev. �� 3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 cv — F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 100) p pp- 17- Ix �aSBni G�� /lo � i J _ I J _ df^� I)ONVI'S OWNER'S MANUAL & MANAGEMENT PLAN Pup - /_V1? FILE INFORMATION SYSTEM SPECIFI TI Owner Septic Tank Capacity al o NA Permit H oo / r Se tic Tank Manufacturer - o NA Effluent Filter Manufacturer c NA DESIGN PARAMETERS Effluent Filter Model I o NA Number of bedrooms o NA Pump Tank Ca2acity gal s'NA Number of Commercial Unit 6NA Pump Tank Manufacturer ca. NA Estimated flow averse al /da Pump Manufacturer czNA Design flow (peak), Estimated x 1,5 gal/day Pump Model z NA Soil A plicntion Rate I _ gal/day/ft' Pretreated Unit Inl'luenl /hfliuenl (Quality Munddy a Sand l0ravel Filler tJ 1 ;e1 FiK'r F "ats, Oils & Grease (FOG) <30 mg /L rt Mechanical / orolion u Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection o Other. Total Suspended Solids (TSS) <150 mg1L Manufacturer Pretreated Effluent Quality O NA Monthly Average "" Dispersal Cell(s) In- ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) <30 m g /L c At -grade in Mound Total Suspended Solids (TSS) <30�mg /L o Drip-line c Other: Fecal Coliform (geometric mean <10' c fu/ 100mL Maximum Effluent Panicle Size '/e inch diameler y Values typical for domestic (non - commercial) wastewater and septic tank effluent. •♦ Values typical for protratod watewtntor. MAINTENANCE SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every o months 3 -d ears Maximum 3 y s Plump out contents of tanks When combined sludge and scum a uals one third %, of tank volun Inspect dispersal cells At least once every c months ears Maximum 3 Xrb Cleun effluent filter At least once cvery c months .3 our s ins ect um , x;m controls & ularnt At loud oneo ever u months Q your (s) 0 NA Flush laterals and pressure test At least once evctry o mont Q year(s) ANA Other; At least once every o months to ears j&NA Other: At least once every o months o ears A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificatio; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on it ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and Scum in any tank equals one -third ( %,) or more of the tank volume, the entt contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Nisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer, service report shall be providod to the local rQguIoiory authority within 10 days of completion of any service event. rA RT UP AND OPERATION I )r new construction, prior to use of the POWTS check treatment tank(s) for the resence of painting products or other P P P g nemicals that my impede the treatment process and/or damage the dispersal cell(s), If high oonoontmOons U0 detected hay the contents of the tanks(s) removed by a septage servicing operator prior to use, I " r Owner: ZP�r1rrfi.J , (!� Nwror System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent.. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and Jy be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from. existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. C1 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. -0,1 1111. e'site evaluated to identify suitable replacement area. Upon failure the POWTS a soil atid'site - evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. o Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO,NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS , POWTS INSTALL POWTS MAINTAINER Name Name Phone - — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name —S 1J Phone Phone 3 ago 1/ ConveRt'jmal D , 16sconsin Department of Commerce SOIL EVALUATION EPOR? "' Page / of 3 bivision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ' Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must C r-61 K include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot .( / 1 /4,fl,6 1/4 S / TZ q N R E (or) \0 Propert Owner's Mailing Address Lot # Block # Subd. Name o CSM# cl l S � 21 i e� V City / State Zip Code Phone Number El City ❑ Village ® Town Nearest Road J�aM I 1./ 157 yoi.s 1 (7 /s ) 7f'C -- z -7Y on C/ I [� New Construction Use: E? Residential / Number of bedrooms 3 —` Code derived design flow rate So GPD ❑ Replacement _ ❑ Public or commercial - Describe: Parent material i . I l Flood Plain elevation if applicable ft. General comments S Y S n1 el--e d, 7c G • Vo G� �' ` �G oG EfL(• �/ED and recommendations: G �� We V , Ja / ( oa O it Cox ' ^9 — 3 2 Boring F1 Boring // __ � \ in Pit Ground surface elev. fE F g ft. Depth to limiting factor 3l in. S it Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 0 -1 l i► Sil 2 m� c -� 8 :Si 2 Tr c — 3 « $- 0�'� FZ _ S `l /(o L it S 5 Boring # ❑ Boring ® Pit Ground surface elev. Ud ft. Depth to limiting factor 2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -i5 l0 31) 5 ► I 2m ct�k �r C5 • 5 B Z ) 5 -Z 1 10 14r 4 c) — </ 3 7- 5L 2mShk S _ .5 41 - G8 , .s Se G 1M 5A e M r — 4 1 - * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Pie a Print) ignature CST Number Akan �u - 253 309 Address Date Evaluation Conducted Telephone Number 211 + l�l y02 Il 28 -o� 2y?- `46� SBD -8330 (R070) Property Owner / "n3 Parcel ID # Page 2 of Boring # ❑ Boring &pit Ground surface elev. 7• Z ft. Depth to limiting factor 5 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I _ 2 IbX 3, 511 2pnbk .5 8 2 2 -5S. 10Yr41 5 5i c1 Zrri3b c - 3 SL 2m5 C -6 5 - 9 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Property Owne " Parcel ID # Page 2 of 3 Boring # ❑ Boring 1 apit Ground surface elev. Z d ft. Depth to limiting factor 5 g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l - 2 LLX 3h 5i ► 2/, -,obk nn r c s .8 2 12-5'91 Ib 413 Si U Zrn 3b c — 3 2xn5cb _ 9 F] Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Moil :Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 100) PAGE 3 OF N LOT# 3?- LEGAL DESCRIPTIONmi XtiEX,S I T N R 1 ao6W SCALE: 1"= 4 / 0 BM 1 ELEVATION /OG • O BM 1 DESCRIPTION -Joe Q ? eJc p,• P e BM 2 ELEVATION q$ q o BM 2 DESCRIPTION , 6 o L SYSTEM ELEVATION �p '7& 412 Law < f • 0 0 ALTERNATE ELEVATION 99 O d L.0 w er 97 SO CONTOUR ELEVATION ct 7. 00 �► q 9 .O rnZ mt got Line � - ■ 4 la N 4 a o .0 L GIZATURE DATE 01/28/2063 67:38 7157962715 PAGE 07 ST CROP COUNTY SEPT #C TANK MAINTMANCE AGREEMENT AND OWNF - RSIJTP CERTWICATION F01UA )Wner/Buyer r rye S (� �-y S /Tailing Address cj�Y1 w-L- D kj "raperty Address ti V`e. (Wrificationt required from planning Department for new construction) --� D amity /State Parcel Identification Numb" 0 �� — �� `115 lb �� -ss�, C�.11��-71��z-zz�31 BEGAT, DES Tro�r -7 t 01 Mrnmw�. i s N W .: t t l ! N_a I w- Town o£ Praperiy I,acation — /,, � 1,, Sec. . '� Subdivision ra r c P u-n Lot it �- IV 4 fur Certified Survey Map ## .^ . Volume . _Page # �2 ® p age # / Volun�ts g � Warranty Deed ## �� L1_ -J _� Spec house Cl yes P no Lot lines identifiable ❑ yes 0 no `YS M 11Ilr1TFNANC Improper use and maintenance of yoitr septic system could result in its premature failure to handle wastes. Proper u�aintenatrce cortsiats of pumping out the septic tank every threes years or sooner, if needed by a licensed pumper. Who you pat into the tystesm can [affect the functi of the septic tank as a treatmcat stage in the waste disposal systcuL The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastprplumber, journeymanplumber, restrictedplurnberera licensed pumperverifyiug that (1) the on -site' a rastewaterdispostl rystom is to proper operating condition, and/or (Z) alter inspection and pumping (if necessary), the septic tank is less than 113 full of nudge. Uwe. the undersigned have read the above requirements and agree to maintain the private sewage disposal system. vt+ & the dandtnts set forth, herein, as set by the Department of Canuncrcc and the Departmen of Natural Resources, State of W certifx ation stating that Your septic system has been maintained [nest be completed and returned to tho St. Croix County Zoning Ogee within 30 .,t ca ycau expiration date. SIGN OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on ibis forte are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of XA4T rty d above, by virtue of a warranty deed recorded in Register of Deeds Office. F A iCANT DATE *'*"• Any inforttiation that is mis- represennted may result in rite sanitary perraiit being revoked by tit* Zoning Dgxutmep t. fss *s� *• Include with this Application: a stamped Warranty decd front the R egister of Deeds o ffice a copy of the cerlif cd survey neap if reference is made in the warranty deed 1 2210P 473 717639 DOCUMENT N&MBER KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 04/21/2003 09:80AN Midwest Equities, LLC, Grantor, conveys and warrants to E arnest RAbt!" Spinks and Hollylyn Spinks husband and wife, holding as survivorship WARRANTY DEED asninai property, Grantees, the following described real estate in St. EXEMPT # Croix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: 95.70 L p4.f D th;NE P rairie Run being the NW 1/4 of the NE 1/4 and part of the NE COPY FEE: 1 1/4, and part of the SE 1/4 of the NE 1/4, and part of CC FEE: the SW 1/4 of the NE 1/4, all in Section 17, T 29 N, R 17 W, Town of PAGES: 1 Hammond. NAME AND RETURN ADDRESS 018 - 1 - -000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this day of April, 2003. (SEAL) (SEAL) L y J. W 1 s, Ma aging Member of M t Equities, LLC (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. cif �r� 17, COUNTY ) Sf authenticated this day of 20_ Personally came before me this day of April, 2003 the above named Larry J. Wellens (Signature) to me known to be the perso s(s) who executed th, forego' g atrumen a nowledge the same. (,Name Printed or Typed) TITLE: MEMBER STATE BAR OF WISCONSIN !si nature, (If not, ,�.«,...•,. % authorized by 5706.06, Wis. Stats. ) � ` J Be dr �K ' C iName Pranced or Typed) THIS INSTRUMENT WAS DRAFTED BY: �� • • • , 7�tary Publi /K County, Wis. Leo A. Beskar = Ql A 9� - ; V - },commission is permanent. (If not, expiration date :) Rodli, Beskar, Boles & Krueger, S.C. P.O. Box 138 Z River Falls, WI 54022 y W:I cr- W; Op 1 • L SO' i I . 00' i� i _I ' X00 39' 03 E 300. 00' NOW 2 0�3� 300 s o. i I 67.00 - 8 ! `� 2 ' W V 33. 00' -. eo ! 1 . 6 6 1 lu1 0)LU 1 O 1 N US M Q g - 1Q M o OD i , 9e Z �ci ,� a NI 33 3 V tal cC = I N •.J ...�. P U E R( 1 I , 1 `O r N00 I 7 56. 00 �-L.. J V' i N00 39' 03' W 1 I 1 300. 00 1 0 ti l :267.00, 1 Q cn vu I -� 4 C�W� V M I M A O Q y M I L N � ' 1n 1 I • M O) h N tF h N 1 h N � t0 ti � 30 �o 1 kn 1, OD a I 0 1 1 • ' N00 39' ' 03 W 567. 0.0' 1 , I J I I lLl 1 300.00 1 :267.00' 1 1 1 i ( � I co cn LU Q 1 MCt CD ' "/ U N 1 I C D - ---. �; -- m h h ej I N I_ ri N J 2 1 in 00 ................. ............................... 1 i Ii «..... ® ' - -- - - - --- �. a' m L - - - - -- 267. 00'----- - - - - -- - - - - -- - - -- 300. 00 — ! so Z I 00 a S00 39' 03 E 567. 00 ..__-.---•--- W I 40 — . M r P U B L '-- - r -- -- - I I I ~I I SEE I SHEET I 2 I I •I N► of I o I .� W NI ° I I I